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Salyers Group Employment Application

***This company is an at-will, equal opportunity employer***This application is not an employment contract but merely is intended to evaluate suitability for employment. It is the policy of the Company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, and any other legally protected status under state and federal law. It is also the policy of the Company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment is contingent upon completion of a background check.

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Company

Position*

Select the position for which you are applying.

Position*

Select the position for which you are applying.

Position

Date you can start work*

MM

DD

YYYY

Desired salary*

I prefer*

Full-Time

Part-Time

Seasonal

Temporary

I can work*

Days

Evenings

Weekends

How did you hear about the job opening?*

Have you worked for any Salyers Group company before?*

Yes

No

If yes, please provide dates and company*

Personal Information

Name*

FirstLast

Previous Name or Maiden Name

Home Phone*

Alternate Phone

Email Address*

If you do not have an email address, you can create a free account at Gmail.

Address*

Street AddressCityStateZIP Code

Have you lived at this address longer than 5 years?*

Yes

No

Previous Address 1*

Street AddressCityStateZIP Code

Have you lived at any other addresses in the past 5 years?*

Yes

No

Previous Address 2*

Street AddressCityStateZIP Code

Education

Highest Level of Education*

High School Attended*

Location*

Trade School Attended*

Location*

Area of Study/Degree*

Undergraduate College Attended*

Location*

Area of Study/Degree*

Graduate School Attended*

Location*

Area of Study/Degree*

Professional School Attended*

Location*

Area of Study/Degree*

Employment Eligibility

Are you at least 18 years of age and legally eligible for work in the United States?*

Yes

No

Will you work overtime when necessary?*

Yes

No

Have you ever been discharged or asked to resign from a job (involuntarily)?*

Yes

No

If yes, please explain*

Have you been convicted of or pled guilty to any crime?*

This includes any criminal conviction that occurred after your 18th birthday. You should also include any citation for a criminal offense if you paid a fine, even though you did not appear in court. Please do not include any parking or speeding violations. Failure to disclose a criminal offense of any type will result in your termination if you are hired.

Yes

No

Please explain*

Employment History

Please list your last two employers beginning with the most recent.

May we contact your present employer?*

Yes

No

Most recent employer

Location

Please include city, state and ZIP code.

Phone

Position held

Supervisor

From

MM

DD

YYYY

To

MM

DD

YYYY

Pay rate upon leaving

Reason for leaving

Duties

Do you have another employer to list?

Yes

No

Next most recent employer

Location

Please include city, state and ZIP code.

Phone

Position held

Supervisor

From

MM

DD

YYYY

To

MM

DD

YYYY

Pay rate upon leaving

Reason for leaving

Duties

Job-related Skills

Do you have a valid driver's license?*

Yes

No

Driver's license number*

State of issue*

What languages do you speak fluently?*

Please list any computer skills that you have*

Please list any special skills you may have that relate to this position

Please list any professional licenses, designations, certifications, etc., that may relate to this position

Include date granted, name of organization and any other relevant information

Other Information

Resumé

Please upload as a .pdf, .doc/docx, .txt or .rtf file

Accepted file types: pdf, doc, docx, txt, rtf.

Or paste the information here

References

Please provide contact information for up to 3 professional references (must be a supervisor or manager) and upload as a .pdf, .doc/docx, .txt or .rtf file